Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments

Sheila Cristina Ouriques Martins,Eduardo David Gomes De Sousa,Carlos Abanto Argomedo,Daissy Liliana Mora Cuervo,Hector Ignacio Amorin Costabile,Claudia Camejo,Carlos Cantú-Brito,Pablo Amaya,Roberto Crosa,Arnold Hoppe,Ricardo Mernes,Nelson Novarro-Escudero,Thaís Leite Secchi,Gisele Sampaio Silva,Victor C Urrutia,Octávio Marques Pontes Neto,Leonardo Augusto Carbonera,Tony Fabian Alvarez Guzman,Victor Hugo Navia González,Claudio Sacks,João José Freitas De Carvalho,Alan Flores,Nelson Maldonado,Michael Brainin,Ana Cláudia De Souza ,Fernando Góngora‐Rivera ,Hernán Bayona ,Juan Carlos Durán ,Antonio Araúz ,F Mont’alverne ,Mário Muñoz Collazos ,Germán Pérez-Romero ,Denizar Vianna Araújo ,D Melgarejo ,Valery Feigin ,Irving R Santos Carquin ,Miguel A Barboza ,Sebastián Ameriso ,Pablo M Lavados ,Raul G Nogueira

doi:10.3389/fneur.2021.743732

Abstract

Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke.Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting.Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge.Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.

Highlights

Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden
The first actions to reduce the burden of stroke resulting from the I Latin American Stroke Ministerial Meeting in 2018 included: (I) publishing the results of the Ministerial Meeting with the Latin American countries priorities and commitments [3]; (II) implementing a joint registry of quality indicators in stroke care; (III) structuring new stroke centers and encouraging the implementation of stroke units; and (IV) providing education to the population on stroke signs and participating in stroke campaigns of the World Stroke Organization
The publication of the Declaration of Gramado was an important landmark resulting from this event, in addition to the immediate adherence to the international quality indicators registries—Safe Implementation of Treatment in Stroke (SITS-QR)3 or Registry of Stroke Care Quality (RES-Q)4 —by the Latin American countries

Summary

Introduction

Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. Stroke is the first or second leading cause of death in most countries in this region, with about 40% of these deaths occurring during a person’s most productive years of their life [3, 4]. Huge efforts have been made in recent years to improve stroke care in many Latin American countries led by stroke physicians. There are still countless gaps to be addressed: access to stroke prevention and rehabilitation remains limited; most hospitals are not prepared for stroke care; few healthcare professionals are trained and available to assist acute stroke; there are few professional training and public awareness campaigns; funding for stroke programs, research, and education is scarce; and national stroke policies are established only in two countries (Brazil and Chile) [3]

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